COVID-19 Impact on DTP Vaccination Trends in Africa: A Joinpoint Regression Analysis

Aguinaga-Ontoso, Inés; Guillen-Aguinaga, Sara; Guillen-Aguinaga, Laura; Alas-Brun, Rosa; Onambele, Luc; Aguinaga-Ontoso, Enrique; Guillén-Grima, Francisco

doi:10.3390/vaccines11061103

Cited by 8 publications

(10 citation statements)

References 49 publications

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“…The global coverage of DTP3 decreased from 86% in 2019 to 83% in 2020 [ 51 , 88 ]. Similar declines had been found in Africa and Asia [ 44 , 89 ]. In contrast to other regions, Europe experienced a minor reduction in vaccination coverage.…”

Section: Discussionsupporting

confidence: 81%

“…We utilized Joinpoint regression, a methodology that has previously been applied in the examination of vaccination trends [ 44 ]. We calculated the annual percentage change (APC) to gauge the extent of variation in each trend.…”

Section: Methodsmentioning

confidence: 99%

“…This trend was not limited to specific regions but was a global phenomenon with varying degrees of impact across various parts of the world. In Africa, for instance, there was a notable decrease in DTP3 coverage post-2019 [ 44 ].…”

Section: Introductionmentioning

confidence: 99%

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Has COVID-19 Affected DTP3 Vaccination in the Americas?

Aguinaga-Ontoso,

Guillén-Aguinaga,

Guillén-Aguinaga

et al. 2024

Vaccines

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Background: In the Americas, deaths by diseases avoidable with vaccines are a significant contributor to child mortality. An essential means of reducing this is through broad vaccine coverage. The COVID-19 pandemic has posed a potential disruption to vaccine coverage due to its effects on the healthcare system. Objectives: this study aims to evaluate the impact of the COVID-19 pandemic on DTP3 vaccination coverage in the Americas, investigating trends from 2012 to 2022 to identify significant changes, regional disparities, and the overall effect of the pandemic on progress towards global immunization targets. Methods: This study used the coverage data for the third dose of the diphtheria, tetanus, and pertussis vaccine (DTP3) pulled from UNICEF databases spanning 2012 to 2022. We conducted a Joinpoint regression to identify points of significant trend changes. The annual percentage change (APC) and 95% confidence intervals (95% CIs) were calculated for America and its regions. We also used segmented regression analysis. Using the Chi-square test, we compared DTP3 vaccination coverage for each country between 2019 and 2022. Results: Overall, America saw a decrease in vaccine coverage during this period, with an APC of −1.4 (95% CI −1.8; −1.0). This trend varied across regions. In North America, the decrease was negligible (−0.1% APC). South America showed the steepest decrease, with an APC of −2.5%. Central America also declined, with an APC of −1.3%. Our findings suggest a concerning trend of declining DTP-vaccination rates in the Americas, exacerbated in certain regions, in the wake of the COVID-19 pandemic. The absolute decrease in vaccine coverage in the Americas was −4% between 2019 and 2022, with the most important drop being in Central America (−7%). However, six countries reported increased vaccination rates post-COVID-19, led by Brazil, with a 7% increase. Conversely, twenty-two countries registered a decline in DTP3 vaccine coverage, with the average decrease being −7.37%. This decline poses an important challenge to achieving the WHO’s target of 90% coverage for the third dose of DTP by 2030, as evidenced by the reduction in the number of countries meeting this target from 2019 to 2022. Conclusions: The COVID-19 pandemic has impacted vaccine coverage in America, leading to a decrease, especially across Central America.

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Section: Discussionsupporting

confidence: 81%

Section: Methodsmentioning

confidence: 99%

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Has COVID-19 Affected DTP3 Vaccination in the Americas?

Aguinaga-Ontoso,

Guillén-Aguinaga,

Guillén-Aguinaga

et al. 2024

Vaccines

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“…The first dose of measles containing vaccine (MCV1) coverage declined from 71% in 2019 to 69% in 2022 and the coverage of the third dose of PCV decreased from 72% in 2019 to 68% in 2022 ( 7 ). The disruption of routine immunization services resulted from multiple factors, including government movement restrictions, closure of health facilities, discontinuation of outreach services, and diversion of human resources from essential health care services to COVID-19 outbreak response, among other factors ( 5 , 11 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

Informal health sector and routine immunization: making the case for harnessing the potentials of patent medicine vendors for the big catch-up to reduce zero-dose children in sub-Saharan Africa

Adamu,

Jalo,

Ndwandwe

et al. 2024

Front. Public Health

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The COVID-19 pandemic caused a surge in the number of unimmunized and under-immunized children in Africa. The majority of unimmunized (or zero-dose) children live in hard-to-reach rural areas, urban slums, and communities affected by conflict where health facilities are usually unavailable or difficult to access. In these settings, people mostly rely on the informal health sector for essential health services. Therefore, to reduce zero-dose children, it is critical to expand immunization services beyond health facilities to the informal health sector to meet the immunization needs of children in underserved places. In this perspective article, we propose a framework for the expansion of immunization services through the informal health sector as one of the pillars for the big catch-up plan to improve coverage and equity. In African countries like Nigeria, Ethiopia, Tanzania, and the Democratic Republic of Congo, patent medicine vendors serve as an important informal health sector provider group, and thus, they can be engaged to provide immunization services. A hub-and-spoke model can be used to integrate patent medicine vendors into the immunization system. A hub-and-spoke model is a framework for organization design where services that are provided by a central facility (hub) are complimented by secondary sites (spokes) to optimize access to care. Systems thinking approach should guide the design, implementation, and evaluation of this model.

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“…For example, high-income countries, such as Australia and New Zealand, use DTP combination vaccines based on acellular pertussis (aP), which is more expensive and has fewer adverse events, whereas India and Vietnam with lower income levels are consistent with World Health Organization (WHO) recommendations on whole-cell pertussis (wP) [ 3 ]. These inequalities were exacerbated disproportionately during public health emergencies due to inadequate investment, insufficient health infrastructure, and unaffordable prices [ 4 ]. Between 2019 and 2021, the proportion of children completing the primary immunization series of DTP vaccines decreased by 5% globally, the most significant decline in three decades [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Access to DTP-Based Combination Vaccines in Asia–Pacific Countries between 2019 and 2022

Ma,

Sun,

Cui

et al. 2023

Vaccines

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The Asia–Pacific countries are highly diverse in health and economic conditions that may impact vaccine access and uptake. Our study aimed to characterize patterns of health access to DTP-based combination vaccines in 10 countries from 2019 to 2022 using the IQVIA-MIDAS database. The availability, affordability, and accessibility were compared across countries by national health and economic performance indicators using Spearman’s rank correlation coefficient. Our findings showed that the three aspects of access to DTP-based vaccines varied substantially in the Asia–Pacific region, with higher levels in countries with better health and economic performance. Affected by the COVID-19 pandemic, vaccine accessibility fluctuates significantly in lower-income countries, with DTP coverage rates falling by more than 14% in the Philippines and Indonesia between 2019 and 2021. For availability and affordability, Singapore and Malaysia from high-income groups were largely affected, which may be related to health expenditure as a percentage of gross domestic product (Coefficient = 0.39, p = 0.03). Our study indicates that greater attention needs to be paid to national health expenditure and routine immunization services to improve vaccine disparities and increase the robustness and resilience of the vaccine supply chain during public health emergencies.

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COVID-19 Impact on DTP Vaccination Trends in Africa: A Joinpoint Regression Analysis

Cited by 8 publications

References 49 publications

Has COVID-19 Affected DTP3 Vaccination in the Americas?

Has COVID-19 Affected DTP3 Vaccination in the Americas?

Informal health sector and routine immunization: making the case for harnessing the potentials of patent medicine vendors for the big catch-up to reduce zero-dose children in sub-Saharan Africa

Access to DTP-Based Combination Vaccines in Asia–Pacific Countries between 2019 and 2022

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